Διπλή αντιαιμοπεταλιακή αγωγή μετά τους 12 μήνες από stenting. Έχει νόημα;

[Argirios Argiriou]

Optimal Duration of Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation: A Randomized Controlled Trial.

Cheol Whan Lee1; Jung-Min Ahn1; Duk-Woo Park1; Soo-Jin Kang1; Seung-Whan Lee1; Young-Hak Kim1; Seong-Wook Park1; Seungbong Han1; Sang-Gon Lee2; In-Whan Seong3; Seung-Woon Rha4; Myung-Ho Jeong5; Do-Sun Lim6; Jung-Han Yoon7; Seung-Ho Hur8; Yun-Seok Choi9; Joo-Young Yang10; Nae-Hee Lee11; Hyun-Sook Kim12; Bong-Ki Lee13; Kee-Sik Kim14; Seung-Uk Lee15; Jei-Keon Chae16; Sang-Sig Cheong17; Il-woo Suh18; Hun-Sik Park19; Deuk-Young Nah20; Doo-Soo Jeon21; Ki-Bae Seung22; Keun Lee23; Jae-Sik Jang24; Seung-Jung Park1*

Accepted October 1, 2013.

Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, 88 Olympic-ro, 43 gil, Songpa-gu, Seoul, 138-736, Korea sjpark@amc.seoul.

Methods and Results—This is a prospective, multicenter, open-label, randomized comparison trial that was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%) (hazard ratio, 0.94; 95% confidence intervals [CI], 0.66 to 1.35; P=0.75). The two groups did not differ significantly in terms of the individual risks of death from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% CI, 0.42 to 1.20; P=0.20).

Conclusions—Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction or stroke.

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